一般臨床藥物代謝動(dòng)力學(xué)回顧2(1)(參考版)
2025-02-07 17:44本頁面
【正文】 General Clinical Pharmacokiics Review 2 University of Florida Working Professional Doctor of Pharmacy Program Christine Crain,., BCPS Clinical Question? A 60 year old woman is taking quinidine for treatment of atrial fibrillation. She has also been prescribed fluconazole for treatment of a Candida UTI and cisapride to control sx of GERD. Would you expect any of these drugs to interact based on the hepatic enzymes by which they are metabolized? Answer to Clinical Question Hepatic Enzyme(s) Affected Quinidine Inhibits 2D6 Metabolized by 3A4 Fluconazole Potential inhibitor of 3A4 Cisapride Metabolized by 3A4 Drug Elimination Liver Primarily Metabolism Kidney Primarily Excretion Hepatic Clearance The efficiency of the liver in removing drug from the bloodstream is referred to as the extraction ratio (E). With high extraction drugs, E is closer to 1 With low extraction drugs, E is closer to 0 Hepatic Clearance CLH = QHFpCLi QH + FpCLi QH = Hepatic blood flow Fp = Fraction of free drug in plasma CLi = Intrinsic clearance Hepatic Clearance CLH = QHFpCLi QH + FpCLi Drugs with a high intrinsic clearance = QHFpCLi FpCLi CLH = QH Hepatic Clearance CLH = QHFpCLi QH + FpCLi = QHFpCLi QH CLH = FpCLi Drugs with a low intrinsic clearance Intrinsic Clearance High CLi Low CLi propranolol warfarin lidocaine phenytoin morphine theophylline nitroglycerin diazepam Clinical Question? Smoking is known to increase the enzymes responsible for theophylline metabolism. Would a patient with a hist
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